Since two of the plagiarized articles were stolen from JPSP, I contacted both editors, Dr. Charles M. Judd and Dr. Jeffry A. Simpson. Dr. Simpson wrote back right away, advising me to contact the American Psychological Association, which holds the copyrights to all APA journals. I did send an email to the Copyright and Permission office and am waiting to hear back.

The publisher, Scientific Research Publishing, has other journals, as well. Some of them ... also appear to follow the “publish things that were already published, but don’t mention that” principle.

On the organization’s web site, we found barely any identifying or location information. The contact page says “Name: Scientific Research Publishing, Inc. USA” and lists an email address — but we have not found any such corporation in the USA, and email sent to that address has produced no reply. The web site is registered to an organization in Wuhan, China.

Submitted papers should not have been previously published nor be currently under consideration for publication elsewhere. Paper submission will be handled electronically through the PSYCH online system. All papers are refereed through a peer review process.

Every year, BMJ has a special Christmas issue with spoof articles and silly studies. Today's feature examines the relationship between the Dow Jones Industrial Average and the value of coins swallowed by children (Firth et al., 2009):

Main outcome measures Total value of coins ingested and number of incidents of coins versus other objects swallowed, measured before and after the stock market crash of October 2008.

The authors reviewed computerized records from the endoscopy suite at Massachusetts General Hospital:

...we compiled data on all numismatic and sundry detritus acquired (NASDAQ composite index) from children’s gastrointestinal tracts by the paediatric gastroenterology service at our hospital between August 2006 and July 2009. ... We calculated the financial total swallowed and extracted as a fraction of the US$ or 100 cents (FTSE 100 index), and the ratio of patients with coins versus all those with foreign objects removed (pecuniary extraction ratio, PE ratio). We calculated the mean end-of-month closing value of the Dow Jones Industrial Average. We examined whether there was a change in the monthly mean NASDAQ, FTSE, and PE ratio before and after the collapse of the Dow Jones Industrial Average of October 2008.

What did they find? There was no relationship between the value of the stock market and the value of coins swallowed by children, as one might intuitively expect from a population that has no idea that the Dow Jones Industrial Average even exists [except for maybe the 15 (!) year old]:

The patients were aged 1 to 15 years. The NASDAQ composite index was 18. Eleven coins were retrieved from nine patients: three pennies (or cents), five nickels (1 nickel=5 cents), no dimes (1 dime=10 cents), and three quarters (1 quarter=25 cents), giving a total return on ingestment for the period, or FTSE 100 index, of $1.03. Seven other objects in seven children included an unsafe safety pin (open), a battery, a marble, a ballbearing, a magnet, a dentist’s guard, and a rubber doorstopper. The PE ratio was therefore 0.57 (9/16).

...We found no change in the FTSE 100 index (2.3 v 3.1, P=0.77) or PE ratio (0.54 v 0.66, P=0.5) during a period of dramatic Dow Jones (12 537 v 8388, P less than 0.0001), despite the NASDAQ composite index remaining stable (0.4 v 0.5, P=0.75). In other words, despite a massive swing in the stock market there was no concomitant absolute or relative change in paediatric wealth intake against an unaltered background rate of foreign body ingestion.

Nonetheless, the authors bemoan the paucity of gastropecuniary studies and call for further investigations in the numismedical field.

V M Neppe proposed a definition of déjà vu in 1983 as “any subjectively inappropriate impression of familiarity of a present experience with an undefined past”. The definition is precisely worded and provides useful insights into the phenomenon.

The word “any” is intended to convey aetiological neutrality, implying that the experience need not originate from any particular pathological entity, or indeed any cause at all.

The “subjectively inappropriate” nature of déjà vu is critical to its understanding, as it implies insight into the unusual nature of the experience. The subject simultaneously seems to recognise a situation, yet knows that recognition to be impossible. Taking this further, the definition implies (though does not state) that the subject will try to explain the sense of familiarity and struggle to pinpoint its source but, frustratingly, cannot do so.

The variety of epilepsy alluded to is one in which (1) the so-called "intellectual aura" (I call it "dreamy state") is a striking symptom. This is a very elaborate or "voluminous" mental state. One kind of it is "Reminiscence"; a feeling many people have had when apparently in good health... Along with this voluminous mental state, there is frequently a "crude sensation" ("warning") of (a) smell or (b) taste; (or, when there is no taste, there may be movements, chewing, tasting, spitting, implying (?) an epileptic discharge beginning in some part of the gustatory centres), or (c), the "epigastric" or some other "systemic" sensation. ...the "dreamy state" sometimes occurs without any of the crude sensations mentioned...

In the dreamy state, the recalled memory can be recent or remote. The mechanism involved does not appear to be different for these two types, in that the discharge involves only the MTL structures [not temporal neocortex]. This permanent role for the hippocampus and amygdala tends to invalidate the model of memory consolidation proposed by Squire and Alvarez (1995)...

Déjà vécu and visual memories involving recent and remote memories can be explained by the role of the amygdala, the hippocampus and rhinal cortex, whether right or left-sided, in the mechanisms of episodic autobiographical memory. The connections between these structures organize the content and the elaboration of the dreamy state for both remote childhood and recent memories.

These authors also point out that there is a continuum between déjà vécu (the more encompassing term meaning having lived through something before) and visual memory, both of which can occur during spontaneous seizures.

An interesting case study of déjà vu in a patient without temporal lobe epilepsy was reported by Kovacs et al. (2009). The patient, a 22 year old woman, was undergoing deep brain stimulation (DBS) to treat dystonia, a painful movement disorder involving involuntary muscle contractions and contorted posture. Due to a perinatal injury, she developed hemidystonia in her right arm. A stimulating electrode was implanted in the left internal globus pallidus (GPi), one of the output nuclei of the basal ganglia. Numerous papers have demonstrated that DBS in the GPi is effective in relieving the symptoms of dystonia.

Fig. 1 (Kovacs et al., 2009). Localization of the stimulating electrode: (A) coronal MP-RAGE, (B) coronal FLAIR, (C) sagittal MP-RAGE. Visual inspection and application of the electronic version of the Schaltenbrand stereotactic atlas verified that the contact responsible for DV [déjà vu] was situated between the GPi and the underlying white matter. The electrode did not hit the mesial temporal structures.

When stimulation at the deepest contact was turned on, the patient reported déjà vu phenomena:

Preoperatively the patient had never experienced DV. Immediately after turning on the DV-inducing stimulation, she experienced an unusual and obscure feeling. In addition to discomfort and a slight disturbance, the subject had an intact sense of reality; she was able to observe what was going on around her and to maintain verbal and behavioral responsiveness. We defined this period as the standby state for DV (SSDV). The SSDV persisted until stimulation of contact 0 was turned off or the amplitude of stimulation was lowered below 2.7 V.

During SSDV, she experienced impulse DV episodes lasting 4–5 seconds. On these occasions she felt that the situation seemed familiar. No visual or auditory illusions or hallucinations accompanied the DV. In addition, the patient felt neither the ability to predict the future nor unreality about current circumstances.

A SPECT (single photon emission computed tomography) scan was performed during one of the DV stimulation sessions. Like its more expensive cousin PET (positron emission tomography), SPECT measures cerebral blood flow, albeit with lower spatial resolution than PET. Structures in the right medial temporal lobe (contralateral to the stimulating electrode) showed greater blood flow during DV (as did other regions):

Compared with the baseline, SPECT during DV revealed right-sided hyperperfusion of the hippocampus, parahippocampal gyrus, fusiform gyrus, cerebellum, and temporal superior pole, and left-sided hyperperfusion of the cerebellum, operculum, insula, lingual gyrus, precuneus, and middle temporal gyrus. Hypoperfusion appeared bilaterally in the precentral and postcentral gyri, as well as in the frontal (especially supplementary motor cortex) and parietal areas.

Since no other cases of déjà vu have been reported in patients undergoing similar DBS, Kovacs and colleagues speculated that atypical neuroanatomy might have contributed to the phenomenon in this individual. An MRI prior to surgery showed right hemisphere dominance for language. In addition, they speculated on a possible functional relationship between the hippocampus and the contralateral basal ganglia, based on studies in rats. But overall, the authors admit they can't explain the pathophysiology of this unique DBS-evoked déjà vu.

Footnote

1Unorthodox, to say the least. Check out "vortex pluralism" -- his bizarre hypothesis to solve the mind-body problem.

Infantile physical morphology—marked by its “cuteness”—is thought to be a potent elicitor of caregiving, yet little is known about how cuteness may shape immediate behavior. To examine the function of cuteness and its role in caregiving, the authors tested whether perceiving cuteness can enhance behavioral carefulness, which would facilitate caring for a small, delicate child. In 2 experiments, viewing very cute images (puppies and kittens)—as opposed to slightly cute images (dogs and cats)—led to superior performance on a subsequent fine-motor dexterity task (the children’s game “Operation”). This suggests that the human sensitivity to those possessing cute features may be an adaptation that facilitates caring for delicate human young. [NOTE: and perhaps surgical patients.]

"Operation"? But why?

Standard laboratory dexterity tasks score performance as the number of objects successfully moved per second. Because cuteness may not make people faster (only more careful), we used a similar task that was not time dependent: the classic children’s game “Operation” (Hasbro, Pawtucket, RI), in which participants use tweezers to remove small objects (body parts) from confined spaces. This task is similar to standard fine-motor dexterity tasks, but performance can be quantified without reference to speed. Because positive actions directed toward a child likely require physical gentleness, we also used a grip-strength gauge as a measure of physical weakness/gentleness.

In Experiment 1, participants were 40 female freshman at the University of Virginia who were assigned to one of two groups. The experiment involved playing Operation before and after looking at images of high cuteness (puppies and kittens) or low cuteness (dogs and cats). And as the authors predicted, subjects in the high cuteness condition showed greater improvement after viewing the pictures than did those in the low cuteness condition (p=.05).

Experiment 2 did a better job of balancing the images on factors that were ignored in Exp. 1, such as interesting, enjoyable, and exciting. Male undergrads were included as well, to make sure the effect wasn't limited to cooing 18 year old girls. Again, participants in the high cuteness group showed greater improvement than those in the other group at the p=.05 level. The girls and the boys did not differ on this "cuteness effect."

Why is this important?

This is the first investigation to document that immediate shifts in carefulness—indexed here by fine-motor performance—can be elicited by cuteness cues. This suggests that two factors—the importance of physical contact in early mammalian development and the extremely delicate nature of human young—may have exerted evolutionary pressures favoring those who could respond to the presence of cues colloquially described as “cute” with increased carefulness.

In a neuroimaging study, 15 women with IPV-related PTSD were compared to 15 non-traumatized control women in a task that cued the presentation of either positive or aversive images (Simmons et al., 2008). The authors hypothesized that the women with PTSD would show exaggerated neural responses in the insula in anticipation of negative stimuli. This brain region is implicated in interoceptive awareness of bodily states (Craig, 2009), and is responsive to scenes and expressions of disgust (Stark et al., 2007).

Figure 1 (Simmons et al., 2008). Anticipation Task. The fMRI task combined a continuous performance task with the interspersed presentation of affective stimuli. Subjects were asked to press the left or right button on a touch pad on the basis of the shape on the screen. Subjects were instructed before the task that a switch from a blue to a green shape accompanied by a low tone would indicate that a positive image was going to appear on the screen. In contrast, a switch from a blue to a red shape accompanied by a high tone signaled an impending negative image.

A priori regions of interest (ROIs) were selected in bilateral anterior insula and right anterior/middle insula. These ROIs showed greater activation in anticipation of negative vs. positive images in both groups. Furthermore, the PTSD group showed greater signal change than controls in the right anterior/middle insula, as shown below.

Additional connectivity analyses suggested that correlations between activation in the insular regions and the amygdala were weaker in the IPV-PTSD group. The authors speculate that:

...the increased activation in anterior/middle insula observed in IPV subjects with PTSD, in particular on the left side, might represent a neural substrate linking emotional distress, anticipatory processing, and autonomic arousal, which can advance action planning to reduce exposure to the aversive stimuli. Therefore, the anterior/middle insula activation might be interpreted as a “warning signal” that is associated with the anticipation of aversive symptoms such as hyperarousal. This interpretation is supported by the strong functional connectivity between anterior/middle insula and amygdala observed in the current study...

Hyperarousal takes its toll on cognition, however, as demonstrated in another experiment that assessed neuropsychological functioning in a group of women with IPV-PTSD, who showed slower cognitive processing speed than controls (Twamley et al., 2009):

We speculate that the cognitive slowing seen in PTSD may be attributable to reduced attention due to a need to allocate resources to cope with psychological distress or unpleasant internal experiences.

A goal for the future is to see whether appropriate clinical treatment ameliorates this deficit. Overall, however, the best strategy is to stop the violence before it occurs. WHO, CDC, and womenshealth.gov have information on the prevention of intimate partner violence. You can also call the National Domestic Violence Hotline. Feel free to list addition resources in the comments.

More recently, spindle neurons have been found in elephants (Hakeem et al., 2009) and cetaceans such as the bottlenose dolphin, Risso’s dolphin, and the beluga whale (Butti et al., 2009).

Fig. 3 (Hakeem et al., 2009). VEN-containing regions of the elephant brain indicated on coronal section outlines. The locations of the sections are indicated by the vertical lines on the inset tracing of the medial aspect of the brain. The left hemisphere is on the left side of the figure. A: VENs in a dorsolateral [DL] frontal cortical area. B: VENs were present in subgenual [SG] anterior cingulate cortex (ACC)... C: Area FI [frontoinsular], in which VENs were abundantly present. Scale = 1 cm. DM = dorsomedial.

The VEN morphology appears to have arisen independently in hominids, cetaceans, and elephants. The VEN specialization may parallel the emergence of very large brain size in these mammals. The evolution of large brain size may place a special premium on overcoming geometric constraints to maintain rapid transmission of crucial information, and this need may explain the independent emergence of the VENs in these species. There are a few mammals apart from hominids, cetaceans, and elephants that have brains somewhat larger than the apes. It would be interesting to determine whether or not these mammals, such as the giraffes and hippopotamuses, have VENs in parts of the brain corresponding to FI and ACC. If they are present, it would suggest that the VEN morphology may be primarily related to absolute brain size. If not, it would suggest that the VENs may be related to behavioral specializations common to hominids, whales, and elephants.

That's the more measured interpretation, because the abstract says:

The VEN morphology appears to have arisen independently in hominids, cetaceans, and elephants, and may reflect a specialization for the rapid transmission of crucial social information in very large brains.

As of now, the projection targets of the layer V spindle neurons are unknown, but are speculated to include (Butti et al., 2009):

...projections to subcortical regions, such as the amygdala, hypothalamus, and periaqueductal gray, to which the ACC and FI/AI are known to project in primates. Altogether, VENs may be involved in the integration of emotions, vocalization control, facial expression, or social conduct as well as regulation of autonomic visceral, olfactory, and gustatory functions.

Fig. 5 (Hakeem et al., 2009). The phylogenetic distribution of the VENs. Species in which VENs have been observed are indicated by underlines; species which have been examined and found to possess no VENs are indicated by italics. Note that while the African and Indian elephants have VENs,they share this trait only with other large-brained groups (the cetaceans and humans/great apes) and not with their nearest relatives, the rock hyrax, manatee, giant elephant shrew, and tenrecs.

The resulting behavioral syndrome consisted of cortical blindness from the extensive damage to visual cortex, with anosognosia (denial or unawareness) for blindness, amnesia (from MTL damage), and topographical disorientation thrown in for good measure:

Stable neurological picture, several days after onset, was characterized by persistent cortical blindness with absence of awareness of blindness, confabulation and spatial disorientation, recent memory disturbance, apathy, inertia and left hemiparesis[weakness].

Along with all the other sensory and cognitive deficits, it seems like the co-occurrence of apathy and inertia was a good thing...

Saturday, December 05, 2009

Cognitive empathy, or the ability to take another person's perspective, is closely related to (or even synonymous with) theory of mind,

...the ability to attribute mental states—beliefs, intents, desires, pretending, knowledge, etc.—to oneself and others and to understand that others have beliefs, desires and intentions that are different from one's own.

On the other hand, emotional or affective empathy is "emotional contagion" - the ability to mirror an emotional response observed in another person and to experience it vicariously. Dr. Simone Shamay-Tsoory and colleagues (2009a) have developed a model that distinguishes between the two types of empathy, which are represented by separate neuroanatomical systems (see figure below).

The cognitive and affective aspects of empathic abilities were assessed using the Interpersonal Reactive Index. The Interpersonal Reactive Index includes four seven-item subscales, each tapping a different aspect of empathy: (a) the perspective taking subscale, which measures the reported tendency to adopt spontaneously the psychological point of view of others; (b) the fantasy subscale, measuring the tendency to imaginatively transpose oneself into fictional situations; (c) the empathic concern scale, measuring the tendency to experience feelings of sympathy and compassion for others; and (d) the personal distress scale assesses the tendency to experience distress and discomfort in response to others’ observed distress.

The perspective-taking subscale was used as a measure of cognitive empathy, and the personal distress scale was used as a measure of emotional empathy. To assess theory of mind, the ability to detect faux pas was examined using a set of stories developed by Baron-Cohen et al. (1999). For example:

James bought Richard a toy airplane for his birthday. A few months later, they were playing with it, and James accidentally dropped it. "Don't worry" said Richard, "I never liked it anyway. Someone gave it to me for my birthday."

Questions after each faux pas and control passage assessed story comprehension, false belief (i.e., the speaker had a mistaken belief and not malicious intent), faux pas detection, and specific identification of the faux pas. Also tested were recognition of emotional expressions from the eyes, cognitive flexibility, and spatial planning abilities.

The results indicated that the participants with bipolar disorder had lower scores than controls for cognitive empathy, but higher scores for emotional empathy.

A similar effect was observed in the faux pas task, with the patients impaired on cognitive understanding, but not in affective understanding or in recognition of the faux pas. This agrees with prior studies on theory of mind in bipolar disorder (Malhi et al., 2008; Montag et al., 2009). On the other hand, the bipolar individuals showed completely intact performance on recognizing emotion in the eyes and in the spatial planning task. However, they had difficulty in set shifting and reversal learning in the cognitive flexibility task. And greater difficulty with reversal learning was associated with lower cognitive empathy scores, suggesting that cognitive inflexibility contributes to the deficiency in taking another's perspective.

What does this mean?

The present study results suggest that [the likelihood to engage in the process of reflecting on the viewpoint of others] is impaired in bipolar disorder. On the second affective scale, personal distress, the bipolar disorder group actually scored significantly higher than healthy comparison subjects... This indicates a greater tendency to have self-oriented feelings of anxiety and discomfort in response to tense interpersonal settings.

This notion is consistent with the “simulation” theory, according to which individuals impersonate others’ emotional mental states, using their own mental state. Thus, it may be hypothesized that bipolar disorder patients tend to engage in the “oversimulation” of others’ emotions, as reflected in high affective empathy, and as a result, they tend to misinterpret others’ mental states, which is reflected in impaired cognitive empathy and theory of mind.

What are the brain systems that mediate such difficulties in those with bipolar disorder? Returning to the model in Figure 6 (above), Shamay-Tsoory et al. (2009a) associated emotional empathy with the inferior frontal gyrus (IFG) and cognitive empathy with ventromedial prefrontal cortex (VM). How did they determine such a clear dissociation? This was from another experiment that administered the same set of tests to a different population: neurological patients with fairly discrete lesions in each of those brain areas.

Fig. 2 (Shamay-Tsoory et al., 2009a). Group and task (cognitive versus emotional empathy) interactions. Significant interaction between group and empathy type. Patients with VM lesions were impaired in cognitive empathy compared to the healthy controls (HC), patients with posterior lesions (PC) and patients with IFG lesions whereas patients with IFG lesions were impaired in emotional empathy compared to the HC, VM and the PC group.

As with most things, though, the anatomical dissociation wasn't completely clean; there was some degree of overlap, as shown below.

Fig. 5 (Shamay-Tsoory et al., 2009a). Location and overlap of brain lesions according to emotional versus cognitive empathy impairment-groups. (A) Lesions of the emotional-empathy-impaired group (n=6). Four patients had an IFG damage involving [Brodmann] area 44, one had a VM damage and one had a PC damage. Chi-square analysis revealed that lesions involving area 44 were significantly more frequent in this group as compared to the non-impaired group. (B) Lesions of the cognitive-empathy-impaired group (n=7): five had VM damage involving area 10 and 11, one had an IFG damage and one had a PC damage. Chi-square analysis revealed that lesions involving area 10 and area 11 were significantly more frequent in this group as compared to the non-impaired group.

Nonetheless, such human lesion studies can demonstrate the importance of specific brain areas for the cognitive or emotional processes in question, thereby illuminating the underlying neural network abnormalities in psychiatric disorders.

Figure 2 (de Waal, 2008). The Russian doll model of empathy and imitation. Empathy (right) induces a similar emotional state in the subject and the object, with at its core the perception-action mechanism (PAM). The doll's outer layers, such as sympathetic concern and perspective-taking, build upon this hard-wired socio-affective basis. Sharing the same mechanism, the doll's imitation side (left) correlates with the empathy side. Here, the PAM underlies motor mimicry, coordination, shared goals, and true imitation. Even though the doll's outer layers depend on prefrontal functioning and an increasing self-other distinction, these outer layers remain connected to its inner core.

H.M. is now 75 years old. His mobility is markedly reduced because of osteoporosis, another side effect of phenytoin (Dilantin). Although he is in relatively good health, plans are in place for the post-mortem examination of his brain when he dies. He and his court-appointed conservator have both signed his brain donation form, ensuring that the final chapter in his lifelong contribution to science will include a precise description of his brain and documentation of his lesion. His wish to help other people will have been fulfilled. Sadly, however, he will remain unaware of his fame and of the impact that his participation in research has had on scientific and medical communities internationally.

About Me

Born in West Virginia in 1980, The Neurocritic embarked upon a roadtrip across America at the age of thirteen with his mother. She abandoned him when they reached San Francisco and The Neurocritic descended into a spiral of drug abuse and prostitution. At fifteen, The Neurocritic's psychiatrist encouraged him to start writing as a form of therapy.